The Role of Multimodal Analgesia in Spine Surgery

Abstract

Optimal postoperative pain control allows for faster recovery, reduced complications, and improved patient satisfaction. Historically, pain management after spine surgery relied heavily on opioid medications. Multimodal regimens were developed to reduce opioid consumption and associated adverse effects. Multimodal approaches used in orthopaedic surgery of the lower extremity, especially joint arthroplasty, have been well described and studies have shown reduced opioid consumption, improved pain and function, and decreased length of stay. A growing body of evidence supports multimodal analgesia in spine surgery. Methods include the use of preemptive analgesia, NSAIDs, the neuromodulatory agents gabapentin and pregabalin, acetaminophen, and extended-action local anesthesia. The development of a standard approach to multimodal analgesia in spine surgery requires extensive assessment of the literature. Because a substantial number of spine surgeries are performed annually, a standardized approach to multimodal analgesia may provide considerable benefits, particularly in the context of the increased emphasis on accountability within the healthcare system.

Lumbar Laminectomy in the Outpatient Setting Is Associated With Lower 30-Day Complication Rates

“…1 Multimodal pain management regimens have been shown to allow for improved pain control with decreased use of opiods and their associated adverse effects. 26,27 Unfortunately, methods of postoperative pain management were not available for review in the NSQIP database and if a difference existed between the inpatient and outpatient cohorts, this may have played a role in the observed complication rate.…”

Perioperative factors associated with persistent opioid use after extensive abdominal surgery in children and adolescents: A retrospective cohort study

“…At our institution, opioids form the basis of the perioperative analgesic regimen for children undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, and a multimodal approach is typically introduced only when postoperative opioid requirements increase. However, multimodal analgesia has been associated with improved pain scores and reduced opioid consumption in several studies . Of particular interest in this patient population may be the early inclusion of anti‐hyperalgesic agents such as methadone, ketamine, and dexmedetomidine.…”

“…However, multimodal analgesia has been associated with improved pain scores and reduced opioid consumption in several studies. [16][17][18][19] Of particular interest in this patient population may be the early inclusion of anti-hyperalgesic agents such as methadone, ketamine, and dexmedetomidine. There is evidence to suggest that NMDA receptor antagonism by these agents may prevent opioid-induced hyperalgesia and reduce acute tolerance to the analgesic effects of opioids.…”

Preemptive Infiltration with Betamethasone and Ropivacaine for Postoperative Pain in Laminoplasty or Laminectomy (PRE-EASE): study protocol for a randomized controlled trial

“…At present, several pain-controlling methods are available, with opioids being the cornerstone for management of severe acute postoperative pain [2,7]. However, there are many compelling reasons to avoid opioids in surgical patients due to their numerous side effects [8].…”